MEDICARE: MS. JANINE B LARIVIERE LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	3951	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LM0776	OTHER	MA	BLUE CROSS, MA
2	NZ791	OTHER	NY	EMPIRE BLUE CROSS
3	62-52249	OTHER	MA	UBH

General Provider Information

NPI Number	:	1679562854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANINE B LARIVIERE LMHC

Provider Business Mailing Address
First Line	:	153 MONROE ST
Second Line	:
City	:	DOUGLAS
State	:	MA
Zip	:	01516-2307
Country	:	US
Telephone Number	:	508-476-7986
Fax Number	:	508-966-2072

Provider Business Practice Location Address
First Line	:	15 N MAIN ST
Second Line	:	SUITE C - 17
City	:	BELLINGHAM
State	:	MA
Zip	:	02019-1548
Country	:	US
Telephone Number	:	508-966-4002
Fax Number	:	508-966-2072

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	07/08/2007

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